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<!DOCTYPE HTML>
<html xmlns:th="http://www.thymeleaf.org">
<head>
	<link rel="stylesheet" type="text/css" th:href="@{css/records/records.css}" />
	<title>新生儿患儿入院护理评估单</title>
</head>
<body>
	<article class="cl">
		<form action="" method="post" class="form form-horizontal"
			id="form-admin-add">
			<div class="row cl">
				<div class="formControls col-sm-12">
					<h4>一、一般资料</h4>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-3">
					<label>家长姓名：</label><input type="text" class="txt" value=""
						placeholder="" data-tag="家长姓名"/>
				</div>
				<div class="formControls col-sm-4">
					<label>病史陈述者(与患者关系)：</label><input type="text" class="txt"
						value="" placeholder="" data-tag="病史陈述者与患者关系"/>
				</div>
				<div class="formControls col-sm-3">
					<label>联系电话：</label><input type="text" class="txt" value=""
						placeholder="" data-tag="联系电话"/>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-3">
					<label>入院时间：</label><input type="text" class="txt txtw" value=""
						placeholder="" data-tag="入院时间"/>
				</div>
				<div class="formControls col-sm-4">
					<label>收集资料时间：</label><input type="text" class="txt" value=""
						placeholder="" data-tag="收集资料时间"/>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-12">
					<label>入院诊断：</label> <input type="text" class="txt txtWidth800"
						value="" placeholder="" data-tag="入院诊断"/>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-12">
					<label>娩出方式：</label>
					<div class="rbx">
						<input name="fmfs" type="radio" data-tag="娩出方式:顺产" id="fmfs1"/> <label
							for="fmfs1">顺产</label>
					</div>
					<div class="rbx">
						<input type="radio" data-tag="娩出方式:助产" name="fmfs" id="fmfs2"/> <label
							for="fmfs2">助产</label>
					</div>
					<div class="rbx">
						<input name="fmfs" type="radio" data-tag="娩出方式:剖宫产" id="fmfs3"/> <label
							for="fmfs3">剖宫产</label>
					</div>
					<div class="rbx">
						<input type="radio" data-tag="娩出方式:其他" name="fmfs" id="fmfs4"/> <label
							for="fmfs4">其他</label>
					</div>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-12">
					<label>喂养方式：</label>
					<div class="rbx">
						<input name="wyfs" type="radio" data-tag="喂养方式:母乳" id="wyfs1"/> <label
							for="wyfs1">母乳</label>
					</div>
					<div class="rbx">
						<input type="radio" data-tag="喂养方式:配方奶" name="wyfs" id="wyfs2"/> <label
							for="wyfs2">配方奶</label>
					</div>
					<div class="cbx">
						<input name="wyfs" type="radio" data-tag="喂养方式:混合喂养" id="wyfs3"/> <label
							for="wyfs3">混合喂养</label>
					</div>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-12">
					<label>新生儿个人史：</label> <label>第：</label><input type="text"
						class="txt txtWidth100" style="width: 30px" value=""
						placeholder="" data-tag="新生儿个人史:胎次" /> <label>胎</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="新生儿个人史:顺产"/> <label
							for="新生儿个人史:顺产">顺产</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="新生儿个人史:助产" name="sex"/> <label
							for="新生儿个人史:助产">助产</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="新生儿个人史:难产"/> <label
							for="新生儿个人史:难产">难产：</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="新生儿个人史:足月"/> <label
							for="新生儿个人史:足月">足月；</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="新生儿个人史:早产"/> <label
							for="新生儿个人史:早产">早产（</label> <input type="text"
							class="txt txtWidth100" style="width: 30px" value=""
							placeholder="" data-tag="新生儿个人史:早产周数" > <label>）周；</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="新生儿个人史:过期"/> <label
							for="新生儿个人史:过期">过期（</label> <input type="text"
							class="txt txtWidth100" style="width: 30px" value=""
							placeholder="" data-tag="新生儿个人史:过期周数" > <label>）周；</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="新生儿个人史:双胎"/> <label
							for="新生儿个人史:双胎">双胎</label>
					</div>
				</div>
			</div>

			<div class="row cl">
				<div class="formControls col-sm-12">
					<h4>二、健康评估</h4>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-3">
					<label>生命体征：</label> <label>体温：</label><input type="text"
						class="txt txtWidth100" value="" placeholder="" data-tag="体检:体温"
						/> <label>℃</label>
				</div>
				<div class="formControls col-sm-2">
					<label>脉搏：</label><input type="text" class="txt txtWidth100"
						value="" placeholder="" data-tag="体检:脉搏" /> <label>次/分</label>
				</div>
				<div class="formControls col-sm-2">
					<label>呼吸：</label><input type="text" class="txt txtWidth100"
						value="" placeholder="" data-tag="体检:呼吸" /> <label>次/分</label>
				</div>
				<div class="formControls col-sm-2">
					<label>体重：</label><input type="text" class="txt txtWidth100"
						value="" placeholder="" data-tag="体检:体重" /> <label>千克</label>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-3">
					<label>&#12288;&#12288;&#12288;&#12288;&#12288;头围：</label><input
						type="text" class="txt txtWidth100" value="" placeholder=""
						data-tag="体检:头围" /> <label>cm</label>
				</div>
				<div class="formControls col-sm-2">
					<label>身长：</label><input type="text" class="txt txtWidth100"
						value="" placeholder="" data-tag="体检:身长" /> <label>cm</label>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-12">
					<label>意识状态：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="意识状态:觉醒"/> <label
							for="意识状态:觉醒">觉醒</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="意识状态:激惹" name="sex"/> <label
							for="意识状态:激惹">激惹</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="意识状态:嗜睡"/> <label
							for="意识状态:嗜睡">嗜睡</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="意识状态:迟钝"/> <label
							for="意识状态:迟钝">迟钝</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="意识状态:昏睡"/> <label
							for="意识状态:昏睡">昏睡</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="意识状态:昏迷"/> <label
							for="意识状态:昏迷">昏迷</label>
					</div>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-12">
					<label>&#12288;&#12288;哭声：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="哭声:正常"/> <label
							for="哭声:正常">正常</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="哭声:尖叫" name="sex"/> <label
							for="哭声:尖叫">尖叫</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="哭声:呻吟"/> <label
							for="哭声:呻吟">呻吟</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="哭声:微弱"/> <label
							for="哭声:微弱">微弱</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="哭声:不哭"/> <label
							for="哭声:不哭">不哭</label>
					</div>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-3">
					<label>肢体活动：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="肢体活动:正常"/> <label
							for="肢体活动:正常">正常</label>
					</div>
					<div class="cbx">
						<input type="checkbox" id="肢体活动:抽搐" name="sex"/> <label
							for="肢体活动:抽搐">抽搐</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="肢体活动:其他"/> <label
							for="肢体活动:其他">其他</label>
					</div>
				</div>
				<div class="formControls col-sm-3">
					<label>&#12288;肌张力：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="肌张力:正常"/> <label
							for="肌张力:正常">正常</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="肌张力:高" name="sex"/> <label
							for="肌张力:高">高</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="肌张力:低"/> <label
							for="肌张力:低">低</label>
					</div>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-3">
					<label>肢体活动：</label> <label>拥抱：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="肢体活动:拥抱:存在"/> <label
							for="肢体活动:拥抱:存在">存在</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="肢体活动:拥抱:无" name="sex"/> <label
							for="肢体活动:拥抱:无">无</label>
					</div>
				</div>
				<div class="formControls col-sm-3">
					<label>觅食：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="肢体活动:觅食:存在"/> <label
							for="肢体活动:觅食:存在">存在</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="肢体活动:觅食:无" name="sex"/> <label
							for="肢体活动:觅食:无">无</label>
					</div>
				</div>
				<div class="formControls col-sm-3">
					<label>吸允：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="肢体活动:吸允:存在"/> <label
							for="肢体活动:吸允:存在">存在</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="肢体活动:吸允:无" name="sex"/> <label
							for="肢体活动:吸允:无">无</label>
					</div>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-3">
					<label>&#12288;&#12288;&#12288;&#12288;&#12288;</label> <label>吞咽：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="肢体活动:吞咽:存在"/> <label
							for="肢体活动:吞咽:存在">存在</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="肢体活动:吞咽:无" name="sex"/> <label
							for="肢体活动:吞咽:无">无</label>
					</div>
				</div>
				<div class="formControls col-sm-3">
					<label>握持：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="肢体活动:握持:存在"/> <label
							for="肢体活动:握持:存在">存在</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="肢体活动:握持:无" name="sex"/> <label
							for="肢体活动:握持:无">无</label>
					</div>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-12">
					<label>&#12288;&#12288;面色：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="面色:正常"/> <label
							for="面色:正常">正常</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="面色:潮红" name="sex"/> <label
							for="面色:潮红">潮红</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="面色:灰暗"/> <label
							for="面色:灰暗">灰暗</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="面色:苍白"/> <label
							for="面色:苍白">苍白</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="面色:黄染"/> <label
							for="面色:黄染">黄染</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="面色:紫绀"/> <label
							for="面色:紫绀">紫绀</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="面色:其他"/> <label
							for="面色:其他">其他</label>
					</div>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-12">
					<label>口腔黏膜：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="口腔黏膜:正常"/> <label
							for="口腔黏膜:正常">正常</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="口腔黏膜:破溃" name="sex"/> <label
							for="口腔黏膜:破溃">破溃</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="口腔黏膜:鹅口疮"/> <label
							for="口腔黏膜:鹅口疮">鹅口疮</label>
					</div>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-12">
					<label>&#12288;&#12288;皮肤：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="皮肤:正常"/> <label
							for="皮肤:正常">正常</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="皮肤:潮红" name="sex"/> <label
							for="皮肤:潮红">潮红</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="皮肤:干燥"/> <label
							for="皮肤:干燥">干燥</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="皮肤:苍白"/> <label
							for="皮肤:苍白">苍白</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="皮肤:黄染"/> <label
							for="皮肤:黄染">黄染</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="皮肤:水肿"/> <label
							for="皮肤:水肿">水肿</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="皮肤:出血点"/> <label
							for="皮肤:出血点">出血点</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="皮肤:皮疹"/> <label
							for="皮肤:皮疹">皮疹</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="皮肤:皮损"/> <label
							for="皮肤:皮损">皮损</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="皮肤:其他"/> <label
							for="皮肤:其他">其他</label>
					</div>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-12">
					<label>&#12288;&#12288;呼吸：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="呼吸:正常"/> <label
							for="呼吸:正常">正常</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="呼吸:稍促"/> <label
							for="呼吸:稍促">稍促</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="呼吸:困难"/> <label
							for="呼吸:困难">困难</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="呼吸:不规则"/> <label
							for="呼吸:不规则">不规则</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="呼吸:其他"/> <label
							for="呼吸:其他">其他</label>
					</div>
				</div>
			</div>

			<div class="row cl">
				<div class="formControls col-sm-12">
					<label>首次大便：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="首次大便:已排"/> <label
							for="首次大便:已排">未排</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="首次大便:未排" name="sex"/> <label
							for="首次大便:未排">已排</label>
					</div>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-12">
					<label>消化系统：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="消化系统:正常"/> <label
							for="消化系统:正常">正常</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="消化系统:胎粪" name="sex"/> <label
							for="消化系统:胎粪">胎粪</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="消化系统:腹胀"/> <label
							for="消化系统:腹胀">腹胀</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="消化系统:呕吐"/> <label
							for="消化系统:呕吐">呕吐</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="消化系统:便秘"/> <label
							for="消化系统:便秘">便秘</label>
					</div>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="消化系统:便血"/> <label
							for="消化系统:便血">便血</label>
					</div>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-3">
					<label>&#12288;&#12288;脐带：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="脐带:未落"/> <label
							for="脐带:未落">未落</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="脐带:已落" name="sex"/> <label
							for="脐带:已落">已落</label>
					</div>
				</div>
				<div class="formControls col-sm-3">
					<label>&#12288;&#12288;脐周：</label>
					<div class="cbx">
						<input name="sex" type="checkbox" data-tag="脐周:干燥"/> <label
							for="脐周:干燥">干燥</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="脐周:红肿" name="sex"/> <label
							for="脐周:红肿">红肿</label>
					</div>
					<div class="cbx">
						<input type="checkbox" data-tag="脐周:其他" name="sex"/> <label
							for="脐周:其他">其他</label>
					</div>
				</div>
			</div>



			<div class="row cl">
				<div class="formControls col-sm-12">
					<h4>三、专科情况</h4>
				</div>
			</div>
			<div class="row cl">
				<div class="formControls col-sm-11">
					<textarea name="" cols="" rows="" class="textarea" placeholder=""
						 onKeyUp="textarealength(this,100)" id="专科情况"></textarea>
					<p class="textarea-numberbar">
						<em class="textarea-length">0</em>/1000
					</p>
				</div>
			</div>

			<div class="row cl">
				<div class="formControls col-sm-3">
					<label>评估护士：</label><input type="text" class="txt txtw" value=""
						placeholder="" data-tag="评估护士" />
				</div>
				<div class="formControls col-sm-4">
					<label>评估时间：</label><input type="text" class="txt" value=""
						placeholder="" data-tag="评估时间" />
				</div>
			</div>
			<br />
			<br />
			<br />
			<br />
		</form>
	</article>
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					password : {
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					},
					password2 : {
						required : true,
						equalTo : "#password"
					},
					sex : {
						required : true,
					},
					phone : {
						required : true,
						isPhone : true,
					},
					email : {
						required : true,
						email : true,
					},
					adminRole : {
						required : true,
					},
				},
				onkeyup : false,
				focusCleanup : true,
				success : "valid",
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					parent.$('.btn-refresh').click();
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</body>
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